NPIMap

Organization Active NPI

Sweetgrass Pharmacy Carolina Park, LLC

  • Community/Retail Pharmacy
  • Mount Pleasant, SC
National Provider Identifier
1720689276
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SWEETGRASS PHARMACY CAROLINA PARK, LLC
Practice address
3485 Park Avenue Blvd
Mount Pleasant, SC 29466
Phone
(843) 654-4013
Fax
(843) 654-4014
NPI assigned
Nov 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cynthia Feldman, PHARMD, MBA
Title
Owner
Phone
(843) 654-4013

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

3485 Park Avenue Blvd
Mount Pleasant, SC 29466

Mailing address

1952 Long Grove Dr Ste 1
Mt Pleasant, SC 29464-7579
Phone (843) 654-4013

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210104000128 SC Part B Supplier - Mass Immunization (Roster Biller Only) 3577976968 Practice locations: Mt Pleasant, SC

National Provider Directory

National Provider Directory
Tax ID family
Sweetgrass Pharmacy Carolina Park LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1720689276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 LONG GROVE DR STE 1",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647579",
            "telephone_number": "843-654-4013",
            "fax_number": "843-654-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 PARK AVENUE BLVD",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "29466",
            "telephone_number": "843-654-4013",
            "fax_number": "843-654-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEETGRASS PHARMACY CAROLINA PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "FELDMAN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-654-4013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD, MBA"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.